Thermal Damage of the Inner Vein Wall During Endovenous Laser Treatment: Key Role of Energy Absorption by Intravascular Blood
Thermal Damage of the Inner Vein Wall During Endovenous Laser Treatment: Key Role of Energy Absorption by Intravascular Blood
复制标题
静脉内激光治疗期间内静脉壁的热损伤：血管内血液能量吸收的关键作用
DOI：
10.1046/j.1524-4725.2002.01309.x
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发表时间：
2002
影响因子：
2.4
通讯作者：
H. Lehr
中科院分区：
文献类型：
--
作者：
T. Proebstle;M. Sandhofer;A. Kargl;D. Gul;W. Rother;J. Knop;H. Lehr
背景：尽管腔内激光治疗(EVLT)具有临床疗效，但其作用机制尚不完全清楚。目的探讨血管内血液通过吸收激光能量将热损伤有效地转移到静脉壁中的作用。方法在剥离前的活体条件下，用15J/脉冲(940 Nm)的激光照射移植的大隐静脉(GSV)，除注入生理盐水外，还注入血液或生理盐水。对连续切片进行组织病理学检查，以检查特定的损伤模式。此外，不同的半导体激光(810、940和980 nm)在生理盐水、血浆和溶血中体外产生蒸汽气泡。结果在生理盐水填充的静脉中，EVLT诱导的血管壁损伤仅限于激光直接撞击的部位。相比之下，充血的静脉在更偏远的区域表现出热损伤，包括与激光撞击相反的静脉壁。这三种激光都能在溶血中产生蒸汽泡，而在生理盐水或血浆中不能产生气泡。结论血管内血在EVLT中对内静脉壁均匀分布的热损伤起关键作用。
BACKGROUND Despite the clinical efficacy of endovenous laser treatment (EVLT), its mode of action is incompletely understood. OBJECTIVE To evaluate the role of intravascular blood for the effective transfer of thermal damage to the vein wall through absorption of laser energy. METHODS Laser energy (15 J/pulse, 940 nm) was endovenously administered to explanted greater saphenous vein (GSV) segments filled with blood (n = 5) or normal saline (n = 5) in addition to GSVs under in vivo conditions immediately prior to stripping. Histopathology was performed on serial sections to examine specific patterns of damage. Furthermore, in vitro generation of steam bubbles by different diode lasers (810, 940, and 980 nm) was examined in saline, plasma, and hemolytic blood. RESULTS In saline-filled veins, EVLT-induced vessel wall injury was confined to the site of direct laser impact. In contrast, blood-filled veins exhibited thermal damage in more remote areas including the vein wall opposite to the laser impact. Steam bubbles were generated in hemolytic blood by all three lasers, while no bubbles could be produced in normal saline or plasma. CONCLUSION Intravascular blood plays a key role for homogeneously distributed thermal damage of the inner vein wall during EVLT.